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Vitamin D in childhood and adolescence: an expert position statement

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Abstract

Vitamin D is a key hormone in the regulation of calcium and phosphorus metabolism and plays a pivotal role in bone health, particularly during pediatric age when nutritional rickets and impaired bone mass acquisition may occur. Great interest has been placed in recent years on vitamin D’s extraskeletal actions. However, while recent data suggest a possible role of vitamin D in the pathogenesis of several pathological conditions, including infectious and autoimmune diseases, the actual impact of vitamin D status on the global health of children and adolescents, other than bone, remains a subject of debate. In the meantime, pediatricians still need to evaluate the determinants of vitamin D status and consider vitamin D supplementation in children and adolescents at risk of deficiency. This review is the result of an expert meeting that was held during the congress “Update on vitamin D and bone disease in childhood” convened in Pisa, Italy, in May 2013.

Conclusion: The collaboration of the international group of experts produced this “state of the art” review on vitamin D in childhood and adolescence. After dealing with vitamin D status and its determinants, the review outlines the current debate on vitamin D’s health benefits, concluding with a practical approach to vitamin D supplementation during childhood and adolescence.

What is Known:

• Vitamin D deficiency is a worldwide health problem.

• Vitamin D deficiency affects not only musculoskeletal health but also a potentially wide range of acute and chronic diseases.

What is New:

• We reviewed the literature focusing on randomized controlled trials of vitamin D supplementation during childhood and adolescence.

• This review will help pediatricians to appreciate the clinical relevance of an adequate vitamin D status and it will provide a practical approach to vitamin D supplementation.

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Abbreviations

1,25(OH)2D:

1,25-dihydroxyvitamin D

25(OH)D:

25-hydroxyvitamin D

AAP:

American Academy of Pediatrics

AD:

Atopic dermatitis

ARI:

Acute respiratory infection

BMD:

Bone mineral density

BMI:

Body mass index

ESPGHAN:

European Society of Paediatric Gastroenterology Hepatology and Nutrition

IOM:

Institute of Medicine

NHANES:

National Health and Nutrition Examination Survey

PTH:

Parathyroid hormone

RCT:

Randomized controlled trial

UVB:

Ultraviolet B

VDR:

Vitamin D receptor

25-Hydroxyvitamin D:

nmol/L = ng/mL * 2.496

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Conflict of interest

The authors declare that they have no competing interests.

Authors’ contributions

GS, FV, AMB, JCK, GW, CAC Jr, MF, NJS, and MFH prepared the manuscript and searched the literature. Particularly, GS, FV, and MF wrote the sections “Prevalence of hypovitaminosis D and definition of vitamin D status” and “Vitamin D supplementation during childhood and adolescence”; GW and MFH wrote the section “Determinants of vitamin D status”; NJS and AMB wrote the section “Skeletal consequences of vitamin D deficiency”; MFH and CAC Jr wrote the section “Extraskeletal consequences of vitamin D deficiency”; JCK wrote the section “Vitamin D status in pregnancy and neonatal age”; NJS wrote the section “Treatment of vitamin D deficiency.” All the authors reviewed the manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, Pediatric Endocrine Unit, University Hospital of Pisa, Via Roma 67, 56126, Pisa, Italy

    Giuseppe Saggese & Margherita Fanos

  2. Pediatric Unit, San Luca Hospital, Lucca, Italy

    Francesco Vierucci

  3. Division of Endocrinology, Department of Pediatrics, Beatrix Children’s Hospital, University of Groningen, Groningen, Netherlands

    Annemieke M. Boot

  4. Department of Neonatology and Neonatal Intensive Care, The Children’s Memorial Health Institute, Warsaw, Poland

    Justyna Czech-Kowalska

  5. Department of Pediatrics, San Raffaele Scientific Istitute, Vita-salute San Raffaele University, Milan, Italy

    Giovanna Weber

  6. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA

    Carlos A. Camargo Jr

  7. Department of Pediatrics, University Hospital Charles Nicolle, Rouen, France

    Eric Mallet

  8. Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Birmingham, UK

    Nick J. Shaw

  9. Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, and the Vitamin D, Skin, and Bone Research Laboratory, Boston University Medical Center, Boston, USA

    Michael F. Holick

Authors
  1. Giuseppe Saggese
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  2. Francesco Vierucci
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  3. Annemieke M. Boot
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  4. Justyna Czech-Kowalska
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  5. Giovanna Weber
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  6. Carlos A. Camargo Jr
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  7. Eric Mallet
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  8. Margherita Fanos
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  9. Nick J. Shaw
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  10. Michael F. Holick
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Corresponding author

Correspondence to Giuseppe Saggese.

Additional information

Communicated by Mario Bianchetti

Revisions received: 07 January 2015/12 March 2015

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Saggese, G., Vierucci, F., Boot, A.M. et al. Vitamin D in childhood and adolescence: an expert position statement. Eur J Pediatr 174, 565–576 (2015). https://doi.org/10.1007/s00431-015-2524-6

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  • DOI: https://doi.org/10.1007/s00431-015-2524-6

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